Rectus fascial sling for the treatment of neurogenic sphincteric incontinence in boys: Is it safe and effective?

Purpose: While a fascial sling for treating children with intractable urina ry incontinence is often successful in girls, its effectiveness in boys rem ains unclear. We determined the long-term efficacy of a rectus fascial slin g in boys with neurogenic sphincteric incontinence and defined its urodynam ic characteristics for achieving continence. Materials and Methods: We reviewed the charts of all boys who underwent a r ectus fascial sling procedure for neurogenic incontinence to determine urin ary continence status at the most recent office visit or by telephone inter view, the type and dose of anticholinergic and sympathomimetic medications, the frequency of intermittent clean intermittent catheterization, status o f the upper urinary tract and comparative urodynamic findings preoperativel y and postoperatively. Results: We evaluated 7 boys 7 to 19 years old, of whom 4 were postpubertal , who fulfilled study criteria and had a followup of 1 to 9 years. In 4 pat ients a continent stoma was created concurrently at surgery. Postoperativel y all patients were dry during the first 3 months after surgery. At the las t followup 1 patient was completely dry, 3 had occasional nighttime wetting , 2 had occasional stress incontinence, and 1 had frequent daytime and nigh ttime wetting requiring subsequent bladder neck closure. Prepubertal and po stpubertal males performed catheterization without difficulty and all requi red less frequent clean intermittent catheterization and medication postope ratively compared to preoperative status. None had hydronephrosis. Postoper atively urodynamic evaluation revealed normal bladder compliance, improved urethral resistance that did not decay with bladder filling and no uninhibi ted contractions. Conclusions: The rectus fascial sling is effective for increasing bladder o utlet resistance and decreasing the degree of incontinence in prepubertal a nd postpubertal males with neurogenic sphincteric incontinence. It has no l ong-term deleterious effects on bladder function and does not impair the ab ility to catheterize postoperatively. A fascial sling is an effective alter native to bladder neck closure when creating a continent stoma.